What actually happened

The short version is that I’ve had the ablation (see previous post) and the surgeon who did it says that he has a good feeling about it. It’s taken till now to write this because, unlike most people who have ablations, I felt terrible for two days after it — with a headache (normal) and a fever (less normal but not unheard of). The fever was not very high, but high enough to be unpleasant, and meant that the only thing I could bear to do was go to bed, except that on the second night after the operation I had to spend part of the night sitting up on a sofa because my chest hurt too much when I was horizontal. (That was normal, and nothing to worry about.) So today is the first day that I am well enough to do anything as strenuous as writing a blog post.

One of the first things I found out when I arrived at the hospital was that I was having the ablation done under a general anaesthetic. I was quite surprised by this but the surgeon came and explained that he was expecting it to take quite a long time, and that he thought he would be able to do a better job if I was under a general anaesthetic. Since that was my top priority, I was happy to agree, though a little disappointed that I wouldn’t have an interesting and unusual experience that I was expecting to have. (That reasoning was conditional on my needing to have the ablation in the first place — obviously it’s not the sort of experience I would seek out otherwise.)

So I spent the morning being prepared in various ways. I had sticky pads attached to me so that I could be monitored, I had a canula inserted into my left wrist, and I was required to put on hilariously unsexy garments — long white socks with a hole at the end for the toes to stick out (which squeeze the leg hard and reduce the chance of an embolism), “paper pants”, which after the operation were half cut off, and a hospital gown that opened at the back. Another thing I had to do was discuss the risks and sign a consent form. The risks sounded worse than I thought — quite a long list, and quite a number of items being given as 1 to 2 percent. The most worrying was permanent damage to the phrenic nerve, a nerve that takes signals from the brain to the diaphragm. The registrar I spoke to wasn’t very specific, but I think that would have left me short of breath for the rest of my life. That was one of the 1 to 2 percent risks. I’ve just found a paper on the web that says that the risk is between 0.11% and 0.48% (whatever that means). Anyhow, I signed the form. I was later asked twice to confirm that it was my signature.

Eventually the time came and I was wheeled to the operating theatre. I was given a drug that made me feel pleasantly woozy, and after a couple of minutes of that I was out.

Next thing I knew, I was back in my room. My wife was there, and I thought to myself, “Great — survived that.” I can’t remember whether my surgeon was there too or whether he arrived soon afterwards. Anyhow, he told me it had gone well.

The next night was fairly awful, because they were worried that my blood pressure was low, so they came to measure it once an hour. I was fairly uncomfortable, so I had a succession of hours where I would be woken up, would get to sleep with some difficulty, and would be woken up again. So the next day I felt pretty awful, but assumed it was probably the night I’d had. The best part of the night was watching the moment the US election was called for Barack Obama — I was awake, and someone else was listening to it so loudly that I could hear what was going on, so there wasn’t much to lose by watching it myself.

The low point of the whole experience was when the registrar who had explained to me the risks (and also put in a canula with very shaky hands) said to me a rather matter-of-fact way that they had put a stent in one of my arteries. He explained to me that this meant I would be on a certain drug for the next year. I was quite surprised, to say the least. I asked why, and he explained that the artery in question was quite narrow. I said something like, “You mean it was dangerously narrow and they had to do it as an emergency procedure?” and he suddenly said, “Oh wait, hang on, I’ve got the wrong notes.” He came back with the right notes and helpfully explained to me that I had had an ablation. But for a couple of minutes I genuinely believed that I had had a stent fitted.

I was discharged in the early evening the next day, but then had another difficult night (mentioned above), a day in bed doing nothing, a better night, and now part of a morning sitting writing this. But I’m beginning to feel like going back to bed for a while.

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I have a few in-patient survival tips. Always ask for “bottoms” right away. At my university hospital here in the US they don’t seem to automatically offer them and wait until you mention it. If you’re there for more than two days you really should get up and walk around if that is at all possible in order to help circulation in the legs, even with the funny white open toed socks. Even if you’re hooked to a pump, you can unplug the pump from the wall (they have battery backups) and take short walks in the hallway with it. Of course in the hallway you really do need those “bottoms.” You still feel a little indecent and vulnerable though with the open backed gown, so you can request a second gown and put that one on backwards over the usual one so you’re closed up front and back. You look absolutely ridiculous, but if you’re in the hospital for a while you’re probably ill enough that fashion is the last thing on your mind. Always keep a small amount of cash on hand in your room so that you can pay for a newspaper or whatever else a volunteer can fetch for you. Finally, the air in hospitals tends to be very dry, and if you’re on oxygen, the gas coming out of the tube is at zero percent humidity, so your nostrils can get very dry and stuffed up. Get a bottle of saline spray (sold in drug stores and even hospital outpatient pharmacies). Sometimes they have methods of humidifying that oxygen line if you’re having problems.

It is great news that it all went well, apart from the discomfort during recovery that sounds as though it is only short-term.

Getting information from someone else’s notes must be scary. If they check twice that it is your signature on the consent form, and presumably check your wristband before dishing out any drugs they have put you on, they might think about asking you to confirm your name before reading any notes to you.

I suppose that one reason for reeling off all the risks, with percentages attached, is to stop anyone saying in court afterwards that they were not warned. But should they also explain to their less mathematical patients that ten 1% risks does not mean a 99% chance of nothing going wrong, but (assuming independence) only a 90.44% chance?

The registrar quite explicitly said that the risks he was reading me were the ones he was legally obliged to read me. They didn’t seem to bear that much relation to the risks I had found in papers available on the internet, and as you say, if they had all been correct and independent then the risk of a serious complication would have been pretty high.

Your description of the experience rang a lot of bells with me, especially the awful night-after experience. The primary purpose of the finger-clip (did you have one?) seems to be a brilliantly subtle torture device.

Very relieved to see this post! The wrong notes episode sounds like the basis for a very funny comedy sketch (I’d bet Mitchell and Webb could do it justice), but obviously not at all funny to experience it in real life!

Brief update: I went back into atrial fibrillation at about 1:45pm today, but it lasted only about three hours. I had read that AF was common while the heart is still healing after an ablation, but it was quite disheartening — at least until it stopped again. The fact that it stopped now feels to me like evidence that something may have genuinely been changed in my heart, since it has been a very long time since I’ve had an attack that has spontaneously resolved itself within a few hours.

I also had ablation last autumn, for atrial flutter, a dangerous complication of AF in which the heart settles into a regular, but wrong, and in particular much too fast, rhythm. The surgeon told me it takes about 6-8 weeks for all the inflamation in the heart to settle down afterwards, so a few short bouts of AF in the next few days is nothing to worry about.

You can feel lucky about the general anaesthetic — I was conscious for the first go at my ablation and it was really quite painful. In the end they gave up and I came back a month later for a second try under anaesthetic. I spent most of the intervening month in hospital just in case, which was monumentally boring.

My top two recommendations for surviving as an inpatient, just in case you end up back in for some reason are earplugs and a kindle.

If we were to model you as a state (and let’s be honest, who does not get excited by that? Even a professional mathematician), you would now be in the “waiting time”, suppose I had a discrete distribution:

A) You would have survived all the “risks”, which were at specific time intervals, other than that you would be safe. Essentially you would be walking on an increasing step function, at risk only at specific times.

B) This waiting time, after the operation, now determines how your function progresses over the future. Will the force of transition change?

If you were to be modelled with a continuous distribution, it makes more “sense”. Now we only really care about whether the force of transition (your condition) has changed (ie decreased) or is the same?

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